Thursday, January 23, 2014

Models of Public Healthcare: An Overview

Are you working class but working a job without insurance?  Or perhaps you're barely getting by and have no real spare money for much these days.  Do you avoid the doctor cause of the cost of the office visit plus the cost of the lost pay from work?  There are simpler and more efficient solutions out there in the world about how we deliver healthcare services to our citizens.  So, how would a national single-payer system established in the United States look?

Let's examine a few models for single payer healthcare that we already see in this country.  Let's start with Medicare/Medicaid.  Both programs do the same thing but for different demographics.  If we created a system like Medicare...but for all, the system would create a single base policy that all states would adopt as their state-managed policy.  States then would choose whether to leave that policy intact or to add to it at their expense.  In Medicare, each state manages it's own program, uses it's own employees to enroll people in the program, pay the bills incurred by that state's program participants, and so forth.  It's mandated and paid by the Federal Government, managed by the State government.  Such a relationship would easily work for our nation, because the infrastructure is already in place.

Another model for care that the US could employ would be complete nationalization of all healthcare resources like that of the VA Healthcare System or the UK National Health Service.  These services are truly a pure socialist system.  In these systems, the primary care providers, ER doctors, surgeons, specialists, and other professionals are "state" employees (State meaning publicly paid federal employees).  In the UK, most hospitals and doctors are public employees which are paid salaries by the state and who centrally manage appointments, doctors, the master policy of the program...the works.  Private healthcare doesn't exist for the most part in these kinds of systems.  The VA system is modeled on the UK system, and for the most part works very well.  The quality of care is great and the attention to the patient's need is paramount.  The focus of the UK and VA healthcare systems is enabling access to all equally with a relatively strong amount of triage being taken into account as well.  Such a system is very effective in the UK and works very well.  The only complaint about such systems are they tend to be a tad backlogged for generic appointments and can result in long queue times.  However, for people who are ill, it's a nice benefit to be able to walk into a doctor's office and be seen when you're ill without any worry about cost to yourself.

Finally, another model which would likely be the model we use could be the Canadian Single Payer model.  This model is essentially each state having it's own healthcare program with a baseline program that the Federal Government creates to make it Universal.  In this arrangement, each state would be responsible for funding and managing it's own health program with transfer payments from the Federal Government to assist...likely based on a "per head" formula.  Some states can compete for which offers the best care by providing access to additional kinds of care like dental or vision services.  Such care would likely be paid for by either a consumption tax or a flat-rate percentage excise tax that all citizens pay equally. Each state would be responsible for determining what funding model to use to pay for their services whether income-based or consumption-based.

All these models are not out of reach for our nation.  Each has a strong history of success and the persistence to provide healthcare for all our citizens.  The Single Payer question has been one about human rights.  Is healthcare a profit-based service or an inalienable right as a member of a nation?  I, personally, believe it's a right for all citizens.  And that the quality of life is paramount to the right to offer for-profit service in this regard, but I also want to be clear...that I believe every person's labor is worth the effort and education and demand that is due, and that no person should be required to "give" their labor away for free.  Individuals who work in such systems get paid, and paid quite well.  Doctors in nations like Canada and England enjoy a posh salary, no worry about malpractice insurance, and the opportunity to help those in need without worrying about insurance companies.  Ultimately, the fabric of our society is what will determine the answer tot his question for the next two generations.

Friday, January 10, 2014

Democrats Are the People's Party, Republicans are the Corporatists Party

I agree with the premise that everyone has the inalienable right to be successful, to start a business, to earn money so long as it doesn't hurt others, to compete in a competitive market, and to strive for efficiency and advancement using economics as a means of doing so. Republicans have no interest in creating a legal framework which allows you as business or individual to challenge corporate power. We see this example where large corporations are now allowed to require you to sign away your rights to enter into a class-action lawsuit against a of the greatest mechanisms that consumers had to fight corporate abuse. Or the abuses by natural or publicly regulated monopolies or privatized public institutions like prisons. Then there's the free trade agreements with various poor nations which allow corporations to send jobs for substandard labor costs at the expense of our own labor force. The Trans Pacific Partnership which would give corporate giants enormous power to override local democracies decisions about food and product regulation. Too much power is being given to corporations at the expense of the citizen and the worker. If you want a competitive society and a world where everyone's opportunity to be successful is tallied by the amount of hard work they put into a goal, then you want to vote for Democrats. Democrats have been fighting for social justice, for policies that create a fair and competitive business environment, and a system of justice that is fair and equitable. A system where corporations don't buy politicians. Where we have a congress that cares that they have a 9% approval rating instead of ignoring it like this congress has. Where people are put first before profits, and where abusers of their power are brought to justice and prosecuted to the fullest extent of the law regardless of the cost. Vote for Democrats when you vote this next midterm election and embrace a political party that cares about the little guy as much as the big guy equally. Vote for Democrats if you want a party that puts pragmatism ahead of ideology, and Vote for Democrats if you want a government that doesn't try to shove narrow-minded values down your throat by the way of legislation. Vote Democrat.  

Thursday, January 9, 2014

Income Taxes: The Hedge Against Extreme Poverty and Wealth

For many decades, the income tax has been used by many governments across the world to maintain a balance in the levels of income allocation among it's citizens.  After World War II, President Franklin D. Roosevelt instituted what was regarded as a progressive income tax system which levied very high taxes on what the government considers high levels of income.  The idea of the income tax was to ensure that the government would have sufficient money to invest in society as a whole while also ensuring that individuals did not gain huge amounts of influence as to topple the system of government which is by and for the people.  In the 1950s, the top marginal tax rate peaked at 91%, but we also steady, continuous economic growth which persisted mostly above 3% for over 40 years.  It wasn't until the early 1980s that such growth started to wane and unstable levels of growth and contraction became the new norm.

Five Years After Crash, Doubts about U.S. Economic SystemWith the flattening of the income tax and the loopholes that have been injected into it, the wealthy now pay rates as low as zero, as high as only 35% at most.  Also consider, that with the redefinition of certain types of incomes making the tax rate for personal incomes significantly lower than the current 35% threshold which was created during the Bush Administration.  Capital Gains, investments, and interest are taxed at a meager 15% meaning that the wealthy don't pay what they otherwise would pay.  This income type is the exception rather than the rule.  Only the top 1% gain their income by this manner, meaning that no working class person will see tax rates this low ever.  And while the wealthy may pay more monetarily...proportionally they pay significantly less.  The results have caused a severe concentration of wealth at the top and for the first time in 50 years, the middle class is shrinking quickly.  Wages, disposable income, savings, and investments of the middle class have been wiped out entirely, leaving the next three generations in a position of having to figure out how they will retire when they hit 60 years old.  It also puts them in a position of trying to figure how to provide for a college education for their children, to buy a house, to start a family, and leaving an entire generation of citizens with no means of secure self-sufficiency for the foreseeable future.  A public opinion study done by the Pew Research Center shows that Americans are still very unsure about their job security and worry about whether they'll be employed the next month or not.  Such insecurity has weakened the bargaining power of the American Worker, and has also resulted in a down-ward pressure on wages across most unskilled to moderate-skill industries.  The downward pressure of incomes has also resulted in the middle class being dropped out of tax brackets that they would have been in had their incomes continued to grow at a steady rate.  The free trade agreements, deregulation, and overall decreases in wages have also all resulted in many American households no longer paying taxes.  During the Reagan Administration, the argument about broadening the tax base was made as a justification for lowering taxes.  That reduction resulted in the wealthy exerting an undue amount of influence in congress, touting proposals that work to undermine the political influence of the middle class and the poor.

So what's the solution to all this grim news?  The solution is to return us to policies and legal frameworks which protected the middle class of the Post-War era.  The pro-union, populist, and pro-worker agenda which brought about the greatest expansion in US History, and created a middle class that had never existed in the history of our nation.  The wealthy weren't super wealthy and the poor weren't super poor.  Everyone was pretty flat with minor differences in income levels.  That balance made sure that the populace was involved in politics.  The higher rates alongside with pro-wage tax deductions for businesses keep money circulating throughout the economy, maintaining a purchase-powerhouse of a middle class, and a friendly investment environment.

Fight the good fight.